approach to assessing children Flashcards
what is the general approach to paediatrics?
holistic multi-system approach
starts with the age
consider common differentials
what is different from adults in the approach to children?
- parents/carers present
- play is essential and clinically helpful
- specialised nursing staff
- treatments differ by weight and age
what questions may you think about when preparing for a paediatric encounter?
- why have they come to see you or been referred to the hospital or clinic?
- child’s name, age and sex
- observation of child before
- likely differential diagnosis
- conditions to rule out
- information gathered by nurses
why is it important to take a good history?
- gather important info: help target examination
- diagnosis: rule out significant pathology
- facilitates in dealing with concerns and anxieties
what are the key stages of a paediatric history?
introduction presenting complaint history of presenting complaint birth history PMH immunisation development drugs and allergies family history school and nursery parent social history
how much weight should a baby gain?
- 100g per week till 6 months
- 20 - 30g per day
- up to 10% loss in the first few days is common
How much feed should a baby take?
140 - 180ml/kg per day
what should you ask about a baby/child’s poo?
- nappies vs toilet trained
- frequency (per day/week/month)
- size, shape, appearance and consistency
- difficulties passing
- pain on passing
- blood or mucus
what are the 2 ends of the Bristol stool chart?
type 1: hard pellets
type 7: entirely liquid
How can concerns be addressed and a closure to a consultation be achieved?
- What made them come to see you today?
- What concerns do they have?
- What were they looking to understand?
- Summarise key features
- Check understanding and safety net
- Document history and discussions
- Note date, time, who was present/ gave history
what should be examined in paediatrics?
ABCDE and baseline observations/ vital signs
general condition and peripheries
systems: respiratory, cardiovascular, alimentary, neurological, musculoskeletal, ENT and skin
developmental skills
measurements and centile
How can an examination be commenced in paediatrics?
- observation first
- friendly and smile
- get down to child’s level
- speak to the child
- be careful moving them
- gentle handling and gradual exposure
- show interest in toys and play
what do you observe for in each system in paediatrics
general: appearance, play, interaction, obs
resp: effort, noise, rate, recession, O2, nebs
CVS: colour, perfusion
GI: feeding, vomit, abdo distension/ movement
neuro: alertness, interaction, play, posture
MSK: mobility, limbs movements, posture, splints, mobility aids
other: rashes, bruises, infusions, tubes, lines
toys, pictures, cards, games, caffeine, books
describe the general examination done in paediatrics
hands/arms: warmth, cap refill, radial/brachial pulses (rate/ rhythm), clubbing, nail changes, hand skills, pen marks
head/face: eyes (jaundice), lips (colour, moisture), tongue, nose, scalp changes, bruises, rashes, fontanel, neck (rashes, nodes, tracheal tug)
chest/back: murmurs, apex beat, thrills, chest expansion, breath sounds, percussion, resonance and fremitus?, rashes and skin marks, spine alignment, deformity, sacral dimples
abdomen and groin: tenderness, masses, organomegaly (liver, spleen, kidney), bowel sounds and bruits, femoral pulses, hernias (and testis), genital/ anal appearance (routine in nappies but often not appropriate for older children)
legs/feet: mobility, changing posture, movements, tone, reflexes, power, coordination, pulses, warmth, cap refill, colour, mottling, rashes, bruises, marks, deformities and gait
